Warfarin (Coumadin) is an anticoagulant and interferes with the action of:
- A. Platelets
- B. Vitamin K
- C. Calcium
- D. Vitamin B12
Correct Answer: B
Rationale: The correct answer is B: Vitamin K. Warfarin inhibits the action of vitamin K, which is essential for blood clotting. By interfering with the production of certain clotting factors, warfarin helps prevent blood clots. Choices A, C, and D are incorrect because warfarin primarily affects the vitamin K-dependent clotting factors and not platelets, calcium, or vitamin B12.
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When assessing the integumentary system of a client with anorexia nervosa, which finding would support the diagnosis?
- A. Preoccupation with calories
- B. Thick body hair
- C. Sore tongue
- D. Dry, brittle hair
Correct Answer: D
Rationale: The correct answer is D: Dry, brittle hair. Dry, brittle hair is a common sign of malnutrition, often seen in clients with anorexia nervosa. Preoccupation with calories (choice A) is more related to the psychological aspect of anorexia rather than a physical finding. Thick body hair (choice B) is not typically associated with anorexia nervosa. A sore tongue (choice C) can be seen in conditions like vitamin deficiencies or oral health issues but is not specific to anorexia nervosa.
The nurse is administering a beta blocker to the client diagnosed with essential hypertension. Which data would cause the nurse to question administering the medication?
- A. The client's BP is 110/70
- B. The client's potassium level is 3.4 mEq/L
- C. The client has a barky cough
- D. The client's apical pulse is 56
Correct Answer: D
Rationale: The correct answer is D. A beta blocker should be withheld if the apical pulse is below 60, as it can further decrease the heart rate. Choice A is not a reason to question administering a beta blocker as the blood pressure is within normal range. Choice B is not directly related to the administration of a beta blocker. Choice C may indicate a potential adverse effect of another medication, but it does not specifically warrant questioning the administration of the beta blocker.
What is the initial step in providing healthcare for a patient?
- A. Obtain and interpret vital signs
- B. Determine the needs of the patient
- C. Develop a plan of care
- D. Obtain lab work and x-rays
Correct Answer: B
Rationale: The initial step in providing healthcare for a patient is to determine the needs of the patient. This step involves assessing the patient's condition, listening to their concerns, and understanding what care or treatment they require. Obtaining and interpreting vital signs (Choice A) is a crucial step but typically follows the assessment of the patient's needs. Developing a plan of care (Choice C) and obtaining lab work and x-rays (Choice D) come after understanding the patient's needs and assessing their condition.
The client is recovering from a percutaneous renal biopsy. Which data indicate that the client is complying with client teaching?
- A. The client lies flat in the supine position for 12 hours
- B. The client continues oral fluids restriction while on bed rest
- C. The client's family changed the dressing on return to the room
- D. The family activates the patient-controlled analgesia pump
Correct Answer: A
Rationale: The correct answer is A. Lying flat in the supine position for 12 hours after a renal biopsy helps prevent bleeding, which is crucial for the client's recovery. This position aids in applying pressure to the biopsy site, reducing the risk of bleeding and ensuring optimal healing. Choices B, C, and D do not directly relate to compliance with client teaching after a renal biopsy. Continuing oral fluids restriction, changing the dressing, or activating a patient-controlled analgesia pump are not specific instructions aimed at promoting recovery and preventing complications post renal biopsy.
For a patient on lithium therapy, which dietary recommendation is essential?
- A. Increase caffeine intake
- B. Increase sodium intake
- C. Increase protein intake
- D. Increase fiber intake
Correct Answer: B
Rationale: The correct answer is to increase sodium intake. For patients on lithium therapy, maintaining consistent sodium intake is crucial to avoid fluctuations in drug levels. Increasing caffeine intake (choice A) is not recommended as it can interfere with lithium levels. While protein intake (choice C) is important for overall health, it is not specifically essential for patients on lithium therapy. Similarly, increasing fiber intake (choice D) is beneficial but not a primary concern for patients on lithium therapy.
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